Chair's Column: On the Front Line: Responding to the COVID-19 Pandemic

Apr 1, 2020

Author:

Gillian Hawker

Gillian Hawker
This is an unprecedented time. Together, we are part of history in the making. For most of us, the COVID-19 pandemic will be the greatest acute public health crisis we will ever experience. Each and every day poses new and unique challenges that keep us on our toes. As the situation evolves, we must continually adjust our processes, policies and even perspectives to ensure we are able to meet the increasing COVID-related clinical demands, while at the same time not lose sight of the health and well-being of those on the front line. There is little differentiation between night and day, weekday and weekend. Cell phones are glued to our hands waiting for ‘the call.’ This is truly an extraordinary time.

The past few weeks have seen a frenzy of activity across the Toronto Academic Health Sciences Network (TAHSN), including in the Department of Medicine, to prepare for the pandemic. In my role as Chair of Medicine and Co-Chair for the TAHSNm, the TAHSN medical committee where I represent the Faculty of Medicine, I have been heartened by the desire of hospital leaders across the city to work together to break down institutional silos and, as much as they are able, approach COVID-19 in a consistent manner. As things are moving at breakneck speed, this has not always been achievable, but remains the goal. I applaud the document that has been developed and disseminated to guide professional responsibilities of physicians during the pandemic. Work is ongoing to identify housing for residents and clinicians who need to self-isolate away from loved ones. Regular calls with the OMA have also helped to ensure a consistent approach. Everyone needs more PPE – we are told it is on the way.

TAHSN education, research and professional practice committees have been similarly hard at work leading the COVID-19 response for their respective jurisdictions. There is ongoing advocacy to support re-thinking the RCPSC’s stance on licensing examinations. Restructuring undergraduate and postgraduate education, the enormous research operations that exists across the faculty and hospitals, and deploying the inter-disciplinary workforce needed to meet clinical needs is no small feat.

The Ontario government has struck an overarching COVID-19 response table with an enormous number of sub-committees working hard to address equipment and supplies, human person-power, ICU infrastructure, including repurposing of ORs and possibly pediatric facilities to cope with large numbers of patients requiring care. Many of you are sitting on or chairing these committees and providing the data on which decisions are being made. In particular, I want to applaud the work of our Infection Prevention and Control (IPAC) physicians in infectious diseases whose faces and voices are now regularly heard on the news. A framework for ethical considerations during the pandemic has been developed by the U of T Centre for Bioethics, again with input from members of our department. Thank you to those of you who are leading the pandemic strategies that will continue to keep us well-informed and prepared for the worst.

Within the Department, our staff have been working effectively and admirably from home. Academic activities have, of necessity, taken a backseat to enable full focus on clinical care. As such, the Senior Promotion cycle for 2021 has been pushed back by two months. We have revised our dates accordingly, which are now available on the Senior Promotion Submissions Deadline page. The CFAR 2020 process is underway now, but it is clear that we will have to revise plans for CFAR 2021. For those of you in the midst of preparing your senior promotion dossiers or slated for review in 2021 please don’t panic – we have your backs and understand that ‘regular’ work has been turned upside down by the pandemic! At this moment, the ONLY thing that is important is to ensure you keep well and are able to bring your best to your patients.

The Educational portfolio of our Department is being handled masterfully by our program directors and hospital site leads with the support of the DDDs, PICs and our Vice-Chair of Education, Arno Kumagai. Resident deployment plans have been developed, and in some cases already implemented, based on principles of fairness, level of training, skills and knowledge, and the desire to minimize the number of sites at which any resident is providing clinical care and risk from exposure to COVID-19. Thanks to the work of TAHSN, residents and faculty are now able to work across sites without the red tape of additional credentialing. Zoom meetings and town halls have become the new norm, and it is incredibly reassuring in this stressful time to see ones’ colleague’s faces in addition to voices.

On March 1, Lisa Richardson began her new role as Vice-Chair, Culture and Inclusion. Of the three areas her portfolio will oversee (Mentorship; Equity, Diversity and Inclusion; and Wellness), we recognized that it was the latter that was, as yet, the least well developed in our department. We are hearing from you that you are frightened – we are all frightened. This is completely normal in the midst of all that’s going on. Those of you – residents, fellows and faculty members – who are pregnant, living with a chronic illness or who have people you live with at higher than average COVID risk – likely have a heightened level of stress and anxiety. And for some of you, these feelings may be overwhelming. True to her nature, Dr. Richardson has hit the ground running to advocate for additional resources to support our faculty during this incredibly difficult time. She is working closely with the Faculty of Medicine and our colleagues in the Department of Psychiatry – a detailed plan will go live very shortly. In the meantime, please go to the DoM website where you will find a Wellness Q&A that includes critical information from Drs. Isaac Bogoch, Wayne Gold and Malika Sharma in Infectious Diseases, and a list of vetted wellness resources for faculty and trainees. These resources will be updated regularly by the Department.

Our colleagues in QI, led by Kaveh Shojania, Vice-Chair of Quality and Innovation, and Brian Wong, Director of CQuIPS (Centre for Quality Improvement and Patient Safety) have rapidly launched a city-wide initiative, building on foundational work by Drs. Geetha Mukerji and Payal Agarwal at Women’s College Hospital, to provide support to long-term care facilities to reduce unnecessary referrals and transfers to the emergency department. Similarly, our researchers have been swift in responding to calls for proposals related to COVID-19; many have pivoted their research efforts towards addressing critical knowledge gaps with regards to the prevention and management of COVID-19 infection. From engaging in global drug trials of potential treatments, to creating interactive tools to help hospitals manage the impact of COVID-19, our researchers and clinicians are at the front of the pack to find solutions. Still others are using their skills, knowledge and innovations to advise governments on their response to COVID-19. Our own Dr. Kamran Khan, founder of the AI firm BlueDot, has partnered with the Canadian government to support modelling and monitoring of COVID-19 and guide government decision-making. Under the leadership of Vice-Chair, Research, Mike Farkouh, the Department has put out a call for seed funding to support this work. We encourage you to work together on these initiatives!

While it is truly remarkable what can be accomplished in times of crisis, I want to re-emphasize that our primary focus at this time is to serve our patients, and to keep ourselves well in order to do so. If teaching, research or other scholarly activities - even revising your dossier for promotion - becomes impossible due to your responsibilities for provision of care on the front line, so be it. Let it go. This is why we trained as physicians.

Thank you to all of you who are staffing the emergency departments, the medical wards and the ICUs in this uncertain period. Thank you again to our IPAC and infectious diseases colleagues who are guiding us. Thank you also to those of you who have rapidly adapted your practices to provide virtual care to chronically ill patients to reduce their need for hospitalization, or who have identified alternate methods by which to provide care to at-risk populations, such as patients with cancer or patients experiencing homelessness. I anticipate that some of these new ways of practicing will become ingrained in our practices for the future.

I am so very honoured to work with all of you – you are the cream of the crop and your ability to step up and lead, care, innovate, research and learn in times like this is absolutely astounding. You have my utmost respect and admiration. You have had to step up and forward into the fray and you have done so with courage and determination. If there was ever a time to come together as one community – one family, one University – it is now. And sure enough, that is what you are doing! Thanks to the extraordinary efforts of people like you, I am confident that we will effectively meet and overcome the current challenges.